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B-scan ultrasound, visual electrophysiology and perioperative videoendoscopy for predicting functional results in keratoprosthesis candidates
  1. Luzia Diegues Silva1,2,
  2. Albert Santos1,
  3. Flavio Hirai1,
  4. Norma Allemann1,2,
  5. Adriana Berezovsky1,
  6. Solange Rios Salomão1,
  7. Paulo Ricardo Chaves de Oliveira1,
  8. Gabriel Andrade1,
  9. André Maia1,
  10. Luciene Barbosa de Sousa1,
  11. Lauro Augusto de Oliveira1
  1. 1 Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
  2. 2 Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, United States of America
  1. Correspondence to Lauro Augusto de Oliveira, Rua República Do Iraque, 855, Apto 51, 04611-001, São Paulo – SP – Brazil; laopadilha{at}


Background/Aims We analysed the ability of B-scan ultrasound, ocular electrophysiology testing and videoendoscopic examination for predicting visual prognosis in Boston Type 1 keratoprosthesis (KPro-1) candidates. Indirect anatomical and electrophysiological findings and results from direct endoscopic evaluations were correlated with postoperative functional data.

Methods In this prospective and interventional study, we included 13 individuals who had previously been indicated for Kpro-1 surgery. All subjects underwent preoperative screening, including ophthalmic evaluation, B-scan ultrasound, electrophysiological testing, and perioperative intraocular videoendoscopic evaluation (VE). B-scan ultrasound, electrophysiological testing, and VE evaluation results were categorised as favourable or unfavourable predictors of postoperative functional results according to predefined criteria. The predictability values of B-scan ultrasound, electrophysiological testing, and VE prognostication were calculated based on the visual acuity level achieved.

Results All surgeries and perioperative VEs were uneventful. Preoperative best-corrected visual acuity (BCVA) ranged from light perception to counting fingers. The 1-year postoperative BCVA was better than 20/200 (satisfactory visual acuity result) in 10 eyes (76.9%) and 20/40 or better in 5 eyes (38.5%). B-scan ultrasound presented a positive predictive value (PPV) of 85.7% for satisfactory postoperative visual acuity, electroretinography showed a PPV of 66.7%, and visual evoked potential presented a PPV of 66.7%. The perioperative VE PPV of a negative finding for satisfactory visual acuity was 100%.

Conclusions Fundoscopic visualisation by intraocular VE is a minimally invasive procedure that can be used to predict functional outcomes in keratoprosthesis candidates. This technique demonstrated better prognostication in keratoprosthesis candidates than B-scan ultrasound and electrophysiological testing.

  • Cornea
  • Prosthesis
  • Treatment Surgery

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  • Contributors LDS, AM and LO: research design, data acquisition and/or research execution, data analysis and/or interpretation and manuscript preparation. AS: data acquisition and/or research execution. FH: data analysis and/or interpretation and manuscript preparation. NA, AB, SRS, PRCdO and GA: data acquisition and/or research execution and manuscript preparation.

  • Funding The study was supported by a grant from CAPES – Ministério da Educação – Brasil (PNPD 2374/2011).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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